Background; Implementation of screening guidelines for domestic violence ha
s been challenging. The multifaceted "systems model" may provide an effecti
ve means to improve domestic violence screening, identification, and interv
ention in the healthcare setting.
Methods: We developed: (1) a systems model approach using tools for effecti
ve referral, evaluation, and reporting of domestic violence; (2) materials
for distribution to female patients; (3) training for social service and me
ntal health clinicians to provide domestic violence evaluation; and (4) str
ong links to the community.
Setting: A nonprofit, managed care facility in Richmond, California.
Participants: Staff and members of the managed care plan.
Main Outcome Measures: (1) Increased screening for domestic violence by cli
nicians; (2) increased awareness of the healthcare facility as a resource f
or domestic violence assistance; and (3) increased member satisfaction with
the health plan's efforts to address domestic violence.
Results: The number of clinician referrals and patient self-referrals to an
on-site domestic violence evaluator increased more than twofold. A pre-int
ervention and post-intervention phone survey of members seen for routine ch
eckup showed an increase in member recall of being I asked about domestic v
iolence. After intervention, statistically significant increases were seen
in members' perception that the health plan was concerned about the health
effects of domestic violence (p <0.0001) and about members' satisfaction wi
th the health plan's efforts to address this issue (p <0.0001).
Conclusions: A systems model approach improved domestic violence services i
n a managed care health setting within I year and affected clinicians' beha
vior as well as health plan members' experience. This successful implementa
tion makes it possible to address critical research questions about the imp
act of a healthcare intervention for victims of domestic violence in a mana
ged healthcare setting.